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Mental health of women and children experiencing family violence in conflict settings: a mixed methods systematic review

Delan devakumar.

1 Institute for Global Health, University College London, London, WC1N 1EH UK

Alexis Palfreyman

Amaran uthayakumar-cumarasamy.

2 Hull University Teaching Hospitals NHS Trust, Hull, UK

Nazifa Ullah

3 UCL Medical School, 74 Huntley Street, London, UK

Chavini Ranasinghe

Nicole minckas, abhijit nadkarni.

4 London School of Hygiene and Tropical Medicine, London, UK

5 Sangath, Porvorim, India

6 King’s College London, London, UK

David Osrin

Jenevieve mannell, associated data.

Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.

Armed conflict has significant impacts on individuals and families living in conflict-affected settings globally. Scholars working to prevent violence within families have hypothesised that experiencing armed conflict leads to an increase in family violence and mental health problems. In this review, we assessed the prevalence of family violence in conflict settings, its association with the mental health of survivors, moderating factors, and the importance of gender relations.

Following PRISMA guidelines, we systematically reviewed quantitative and qualitative studies that assessed the prevalence of family violence and the association between family violence and mental health problems, within conflict settings (PROSPERO reference CRD42018114443).

We identified 2605 records, from which 174 full text articles were screened. Twenty-nine studies that reported family violence during or up to 10 years after conflict were eligible for inclusion. Twenty one studies were quantitative, measuring prevalence and association between family violence and mental health problems. The studies were generally of high quality and all reported high prevalence of violence. The prevalence of violence against women was mostly in the range of 30–40%, the highest reported prevalence of physical abuse being 78.9% in Bosnia and Herzegovina. For violence against children, over three-quarters had ever experienced violence, the highest prevalence being 95.6% in Sri Lanka. Associations were found with a number of mental health problems, particularly post-traumatic stress disorder. The risk varied in different locations. Eight qualitative studies showed how men’s experience of conflict, including financial stresses, contributes to their perpetration of family violence.

Conclusions

Family violence was common in conflict settings and was associated with mental health outcomes, but the studies were too heterogenous to determine whether prevalence or risk was greater than in non-conflict settings. The review highlights an urgent need for more robust data on perpetrators, forms of family violence, and mental health outcomes in conflict-affected settings in order to help understand the magnitude of the problem and identify potential solutions to address it.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13031-021-00410-4.

Introduction

Rates of family violence and mental ill health are hypothesised to be higher in areas of armed conflict than in non-conflict-affected settings [ 1 ], but the extent of the risks and their associations have not been systematically assessed.

Family violence, including violence against women (VAW) from intimate partners or other household members and violence against children, is prevalent across the world and has adverse implications for physical and mental health [ 2 ]. The WHO multi-country study on women’s health and domestic VAW, showed that lifetime prevalence of physical and sexual abuse by an intimate partner ranges from 15 to 71% [ 3 ]. Rates of child abuse vary by type of abuse, definition and location. ‘Base-case estimates’ from 96 countries suggested at least 50% prevalence of exposure to violence in the last year, equating to approximately 500 million children aged 2–17 years [ 4 ]. A systematic review of 55 studies estimated the prevalence of sexual violence to be 8–31% in girls and 3–17% in boys [ 5 ]. Sexual violence in particular is associated with a long-term increased risk of mental and physical illness [ 6 ].

Reports from conflict settings indicate increased rates of VAW and physical and sexual abuse of children by both men and women [ 7 – 9 ]. For example, in a study of child soldiers from Sierra Leone, 44% reported having been raped [ 10 ]. There are a number of possible reasons for this. The social and economic conditions that lead to conflict at a societal level may also result in increases in family violence. Catani et al. propose that the ‘cycle of violence’ model, in which violence is transmitted intergenerationally within a family [ 11 ], can also apply to conflict situations in which external violence leads to violence within the family [ 12 ]. The mechanisms by which this may occur are multiple. Conflict may normalise violence in a society, increase substance abuse, and affect education, income, family composition, and gender attitudes [ 13 – 15 ] .

In addition to violence, mental disorders are common in conflict, due to both the conflict itself and the family violence. Women and children living in conflict-affected settings are at increased risk of developing depressive, anxiety, and psychotic disorders [ 16 , 17 ]. The prevalence of mental disorders in conflict-affected populations is substantially higher than in the average population: 15.4% for post-traumatic stress disorder (PTSD) and 17.3% for depression, versus 7.6% for any anxiety disorder including PTSD and 5.3% for any mood disorder including depressive disorders [ 18 , 19 ].

There remains a gap in knowledge on the prevalence of family violence in conflict-affected areas and its mental health consequences. Greater understanding is needed of why and how family violence may result in an increase in mental disorders in conflict-exposed populations. This review was designed to explicitly investigate links between family violence occurring at an individual level (within families), and broader forms of violent armed conflict occurring within communities. We included both quantitative and qualitative research to both enumerate the problem and explore the reasons why armed conflict is associated with mental ill-health, expanding our conceptual understanding of the underlying causes. Our review had four objectives. First, to investigate the prevalence of family violence, including violence against women and children, in conflict-affected areas. Second, to describe the risk of mental disorder among women and children who had experienced or witnessed family violence in conflict-affected areas. Third, to examine how the association of family violence with mental health in women and children is moderated by the type of conflict, the gender of the perpetrator, and the type of violence. Finally, to understand the ways in which gender relations, as a well-recognised risk factor for violence against women and children [ 20 ], influence the mental health of women and children who experience or witness family violence.

We conducted a mixed-methods systematic review. The protocol was registered prospectively with PROSPERO (CRD42018114443) and reporting follows PRISMA guidelines [ 21 ].

Search strategy

We searched the following databases: EMBASE, International Bibliography of Social Sciences, MEDLINE (PubMed), PsycINFO, Scopus, SciELO, Social Policy and Practice, Sociology database, Global Index Medicus, Online Library of Dignity, Web of Science, Cochrane Library, CINAHL Plus, and regional databases (LILACS, African Journals online, Latin America & Iberia Database (ProQuest), Middle East & Africa Database (ProQuest)). Studies were imported into Endnote and duplicates removed. The search was restricted to articles in English, Arabic, Spanish, Portuguese, and French, with no date restrictions. Database searches were complemented by reference list screening and citation tracking of included materials in Web of Science and Google Scholar.

Search terms

The search strategy (Additional file 1 : Appendix) was designed with the support of a librarian and included terms related to (1) women and children, (2) family violence, (3) mental disorders, and (4) conflict-affected areas. Terms describing conflict-affected areas were compiled using a list of countries and territories in which armed conflicts were recorded before 2018, using the Uppsala Conflict Data of the International Peace Research Institute and the Heidelberg Institute for International Conflict Research. We used the Uppsala Institute interstate and intrastate definitions of conflict: “An armed conflict is a contested incompatibility that concerns government and/or territory where the use of armed force between two parties, of which at least one is the government of a state, results in at least 25 battle-related deaths in one calendar year”; and “A conflict between a government and a non-governmental party, with no interference from other countries” [ 22 ].

Inclusion criteria

Population and setting: Our review included adult women (aged 18 years or older), and male or female children (aged under 18 years). If the study sample included men aged 18 or older, reports were only included if 90% were under 18. We did not include facility-based studies in the assessment of prevalence due to the risk of selection bias, but chose to include school studies to reflect the universal right to education. We included studies up to 10 years post-conflict to capture the ongoing effects of war. Type of study: We included primary research using qualitative (e.g. individual interviews, focus group interviews) or quantitative (e.g. cohort, case–control, cross-sectional studies, or baseline data from experimental or quasi-experimental studies) research designs. Where quantitative studies were reported in more than one publication, the one with the largest sample was selected for inclusion. Exposures: We included family violence against women or children. The definition of family violence, adapted from the United Nations definition of violence against women [ 23 ] was the intentional use of physical force or power by an intimate partner, ex-partner or parent that results in physical, sexual or mental harm or suffering to women and/or children. This includes threats of violence, sexual coercion, psychological abuse and arbitrary deprivation of liberty. Family violence is an overarching term that includes intimate partner violence and child abuse, perpetuated by family members. Studies of children who witness violence against women in the home in addition to experiencing direct violence themselves were included. The comparator group for quantitative studies was no exposure to family violence. Outcomes: Our primary outcome was mental disorder, defined in accordance with the International Classification of Diseases and Related Health Problems (ICD-11) or Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) criteria. Articles were eligible if mental disorder was assessed using either a validated diagnostic or screening instrument, diagnosed by a clinician, or self-reported by participants. The secondary outcomes included were mental and social wellbeing of women experiencing family violence and children experiencing or witnessing family violence.

Exclusion criteria

Population and setting: We excluded soldiers and war veterans, refugees and asylum seekers who had moved away from the conflict setting. Soldiers and war veterans were considered to be too different a population who had experienced combat directly. Type of study: We excluded opinion pieces and editorials, dissertations or theses, policy papers, reviews, general reports that did not introduce new evidence from a specific study, and conference abstracts. Exposures: Other forms of violence against women and children were beyond the scope of the review; for example, peer bullying, violence by perpetrators other than intimate partners, ex-partners, or family members, female genital mutilation or cutting, or child labour or marriage.

Titles and abstracts were screened independently by two reviewers (CR, NU) from 2nd June 2019. Full texts were screened from 31st July 2019. Data extraction began on 1st September 2019 and was completed by January 2020. Disagreement was resolved by discussion and no papers were discussed with a third reviewer. Each full text was then independently reviewed by two authors (two of AP, AU-C, CR, DD, NU, JM). Disagreement was resolved by discussion. One author was contacted for missing data, but did not respond.

Quality assessment

Two reviewers assessed each article (qualitative articles by AP and JM, with disagreements decided by DD; quantitative articles by A-UC and DD) for quality using the Joanna Briggs Institute checklists [ 24 ]. Discrepancies in scoring were discussed between the reviewing authors.

Quantitative studies: We used descriptive statistics to summarise information about the study characteristics, samples, and methods. Ninety-five percent confidence intervals were reported for all measures of prevalence and risk ratios where available. Meta-analysis was not conducted due to study heterogeneity.

Qualitative analysis: We conducted a thematic analysis of selected articles and used NVIVO 12 to organise the data. All articles were read multiple times by two reviewers (AP, JM) to identify initial codes related to the associations between family violence and mental health and the influence of gender relations (Additional file 1 : Appendix), drawing on the accounts of both research participants and the article’s authors. AP and JM discussed these codes to arrive at a consensus and collaboratively developed a final codebook. One reviewer (JM) then went through each article in detail, systematically extracting all relevant quotes. As a descriptive account of the current literature on this topic, further theoretical interpretation beyond a descriptive analysis was not needed.[ 25 ].

Studies included

We identified 2603 records, of which 1682 were duplicates (Fig. 1 ). Of the 173 full-text articles retrieved, 29 studies conducted between 1994 and 2017 in 13 countries were included (Additional file 1 : Appendix). Reasons for exclusion were mostly due to the study not including family violence or not being a full research paper (Additional file 1 : Appendix).

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PRISMA flow chart

The quantitative papers described violence against women and violence against children. We included 14 quantitative studies of violence against women in conflict from 11 countries (five in Africa, five in Asia, one in Europe). All were cross-sectional, with the exception of one cohort study [ 26 ]. The sample sizes for women within these studies ranged from 80 to 2196 individuals (Table (Table1). 1 ). The types of violence included varied. Eleven studies focused on intimate partner violence (IPV). The other studies had broader definitions including violence from other members of the family and other forms of violence (Table (Table1 1 ).

Study characteristics: Violence against women

* The study included women receiving psychiatric treatment. These women were excluded from our analysis

** Vulnerable individuals defined as 'A person who had any of the following characteristics: widowed, divorced, or separated; living in an internally displaced persons camp; women who had suffered sexual torture; single mothers; orphans; out of school youth; child/adolescent mothers; women and adolescent girls without any source of livelihood (mainly lack of access to arable land); having a mental health problem; survivor of intimate partner violence; and survivors of recent famines or floods

We included eight studies of violence against children in conflict-affected countries. All were from Asia except one from Uganda. All were school-based samples except two that were community-based [ 27 , 28 ], which were the smallest (n = 149 [ 27 ]) and largest (n = 513 [ 28 ]). Six studies were cross-sectional and two were cohorts (Table (Table2 2 ).

Study characteristics Violence against children

Eight qualitative studies were included [ 29 – 36 ], presenting research from six countries: Côte d’Ivoire (2), Timor-Leste (2), Colombia (1), Uganda (1), Democratic Republic of the Congo (1), and Sri Lanka (1). Five reports focused exclusively on family violence perpetrated against women, two on violence by mothers against their children, and one on both forms of family violence. Only one report discussed VAW by family members other than the husband. Seven reports used interviews or focus groups and one used a questionnaire. Terms such as depression, anxiety, post-traumatic stress disorder, or suicidal ideation were rarely used. As such, mental health problems were coded as anything that discussed a psychological symptom or negative feelings, including stress, fear, worry, unhappiness, or concern.

We summarise below the results according to our four objectives, including the qualitative and quantitative results together.

Prevalence of family violence in conflict-affected areas

The prevalence of family violence and associations with mental health are shown in Tables Tables3 3 (for women) and and4 4 (for children). Amongst women, the prevalence of violence varied, but exposure to domestic violence in both conflict and post-conflict settings was common. The highest prevalence was a study from Bosnia and Herzegovina, where 78.9% of women reported physical abuse and 96.1% psychological abuse [ 37 ]. Commonly, however, reports of IPV were in the region of 30–40%. Lifetime experience of IPV was reported at 37.7%[ 38 ] from Liberia, 44.6% for those who had 2–4 trauma exposures in a study from Afghanistan [ 13 ], and 49.8%in a study from rural Côte d’Ivoire [ 39 ]. High prevalence was also reported for exposure to IPV within the last 12 months (24.4% [ 38 ], 25.1% [ 13 ] and 29.7% [ 39 ]). No obvious difference was seen by country or region of the world.

Violence against women results

CI, Confidence Interval; CMD, Common Mental Health Disorders; CTS, Conflict Tactics Score; EPDS, Edinburgh Depression Scale, GAD, Generalised Anxiety Disorder; HPS-25, Hopkins Symptom Checklist-25; HTS, Harvard Trauma Scale; IQR, Interquartile range; MDD, Major Depressive Disorder; OR, Odds ratio; SD, Standard Deviation; SRQ-20, Self-Reporting Questionnaire-20

Violence against children results

CDI, Child Depression Inventory; CI, confidence interval; CRIES, Child Revised Impact of Events Scale. Score of 30 or more indicates PTSD; DSRS, Depression Self Rating Scale; OR, Odds ratio; SDQ, Strengths and Difficulties Questionnaire; UPID, UPID, University of California at Los Angeles PTSD Reaction Index for DSM-IV

The prevalence of violence against children varied but in all cases violence was very common. Lifetime experience of violence was reported at 77% from Afghanistan [ 40 ], 88.9% from Uganda [ 28 ], and 83.8% and 95.6% in studies from Sri Lanka[ 12 , 41 ] Similar high prevalences were reported for recent or ongoing violence over the last year (27% [ 42 ], 47% [ 43 ] and 71% [ 27 ]) and last month (35.2% [ 40 ], 64.2% [ 12 ] and 71.6% [ 41 ]). Where the mean number of events was measured, children had experienced 5.3 [ 12 ] or witnessed 4.3 [ 40 ] family violence events.

2. Risk of mental health problems among women and children who have experienced or witnessed family violence

Nearly all the studies found associations between family violence and adverse mental health among women (Table (Table3). 3 ). Depression and PTSD were commonly measured outcomes.

Six studies estimated the association between family violence and mental health outcomes in children. Across all studies, associations were found between family violence and mental ill-health.

Post-traumatic stress disorder

Gupta et al. [ 16 ] found a non-significant positive association between IPV and PTSD (OR 1.6 (95% CI 0.9, 2.6) in Côte d’Ivoire. Johnson et al. [ 44 ] found that in the DRC 43.9% (95% CI 34.7, 53.0) of women not affected by IPV had PTSD, compared with 77.2% (95% CI 66.8, 87.7) who were affected by IPV. A dose–response relationship between compound exposures of violence and likelihood of PTSD was reported by Rees et al. [ 45 ], whereby severe combined physical and psychological abuse was associated with the greatest risk of PTSD (OR 3.24, 95% CI 1.90, 5.50). These findings were comparable with those found in Afghanistan. Jewkes et al. [ 13 ] reported that, of women who had no exposure to trauma, 1.35% had PTSD. Of women with one trauma exposure 1.7% had PTSD, and with 2–4 trauma exposures 1.65% had PTSD (p < 0.0001). Umubyeyi et al.[ 46 ] noted strong positive associations between different forms of violence exposure and PTSD in Rwanda: physical (aOR 3.16; 95% CI 1.67, 5.95), sexual (aOR 4.20; 95% CI 2.22, 7.95), psychological (aOR 2.97; 95% CI 1.62–5.45).

In children, studies from Sri Lanka [ 12 ], Afghanistan [ 40 , 42 , 43 ], Lebanon [ 47 ] and Uganda [ 28 ] all showed increases in PTSD associated with family violence. In comparable studies, Catani et al. [ 12 ] and Catani et al. [ 40 ] showed that exposure to war predicted family violence and PTSD symptoms, and a correlation between family violence and PTSD. Similarly, Fayyad et al. found higher PTSD scores (as measured by the Child Revised Impact of Events Scale (CRIES)) in children who had experienced or witnessed family violence [ 47 ].

Type of conflict

In the quantitative studies, we were unable to directly answer our question as to whether the association between family violence and changes in mental health differed by type of conflict. Only the three studies from Uganda were interstate [ 28 , 48 , 49 ]. No discernable difference could be seen between these and the intrastate conflicts (Democratic Republic of Congo [ 44 ], Côte d’Ivoire [ 16 , 30 , 39 ], Lebanon [ 47 , 50 ], Liberia [ 38 ], Palestine [ 26 ] and Sri Lanka [ 12 , 41 ]), or the internationalised intrastate conflicts (Afghanistan [ 13 , 27 , 40 , 43 ], Bosnia and Herzegovina [ 37 ] and Iraq [ 51 ]).

The qualitative studies also did not engage with this concept and there were no comparative case studies in the review.

Sex of perpetrator

Limited data were available on the prevalence of female-perpetrated family violence, and we were unable to assess whether the association between family violence and mental health problems varied according to the sex of the perpetrator. The majority of studies measuring violence against women focused on male spouses in the context of heterosexual married relationships. Two studies, Usta et al. [ 50 ] and Hossain et al. [ 39 ], defined domestic violence as including violence from family members. In rural Côte d’Ivoire, Hossain et al. [ 39 ] demonstrated the lifetime prevalence of sexual violence from female perpetrators including female family members was 0.1%. Among women, lifetime prevalence of physical violence from female family members was 8.9%; prevalence of lifetime physical violence from male family members was also 8.9%.

Type of violence

We were unable to assess whether the association between family violence and mental health problems varied according to type of violence; only one study provided suitably disaggregated data. Umubyeyi et al. [ 46 ] found that PTSD and generalised anxiety disorder (GAD) were most strongly associated with sexual violence (PTSD aOR 4.20 (95% CI 2.22, 7.95); GAD aOR 6.37 (95% CI 3.45,11.79)), followed by physical (PTSD aOR 4.70 (95% CI 2.65, 8.35); GAD aOR 3.16 (95% CI 1.67,5.95)) and psychological violence (PTSD aOR 4.34 (95% CI 2.54, 7.43); GAD aOR 2.97 (95% CI 1.62, 5.45)). Physical violence was more closely associated with suicide risk followed by psychological violence and sexual violence. Major depressive episode showed the strongest association with psychological violence, followed by sexual violence, and physical violence.

4. Impact of gender norms on the mental health of women and children experiencing family violence

The conflict-related triggers identified in qualitative articles, such as financial stress and alcohol use, were explained by both authors and study participants as rooted in gender norms. In situations of conflict, men may not be able to fulfill their socially-expected roles such as providing financially for the household [ 35 ], and in some cases women become the main household providers [ 30 ]. This has indirect impacts on the mental health of women and children by increasing men’s stress and sense of insecurity in ways that increase family violence [ 29 , 30 , 35 ].

Guruge et al. explained how the use of violence by men becomes a means of maintaining a sense of power and control in the face of the instability brought on by conflict, which threatened gender norms that men rely upon for their identity and sense of security:

With death, disappearances, disability and loss of traditional sources of livelihood (such as fishing) affecting many men, women in war-affected areas of Sri Lanka have taken on being the breadwinner and head of household roles, and have become more active in their communities. When there is a disruption of established social relationships and roles in war and post-war contexts, men are known to use violence as means of re-exerting control and power to maintain roles that are consistent with social norms. [ 35 ]

Related to this, economic instability often opens up new opportunities for women to earn, which men may feel threatened by, contributing to their use of violence [ 29 , 30 , 35 ]. Shuman et al., for example, discussed how change in women’s roles arose in Côte d’Ivoire as an underlying cause of family violence:

In post-crisis Côte d’Ivoire, economic opportunities are scarce and in some cases, women have become the financial providers for their families. While women welcomed opportunities to have more control over resources in their relationships, they also described being perceived as a threat by their partners. Among men, this perceived loss of control and traditional gender responsibilities was discussed as an underlying cause of all forms of IPV. [ 30 ]

The stress reported by men was also highlighted as a reason for their increased drinking behaviour. In Côte d’Ivoire, Northern Uganda and Sri Lanka, instability and financial problems arising from the conflict were seen as triggers for problematic drinking by men, which contributed in turn to increased episodes of violence[ 34 – 36 ].

The qualitative data also support the impact of gender norms on the mental health of women and children experiencing violence directly through their experience of violence-related stigma. [ 29 , 30 ]. Sexual violence was frequently described as especially stigmatising for women. For instance, Annan and Brier’s study of women abducted by the Lord’s Resistance Army in Northern Uganda described the lower status of women who return to their communities as women who had been ‘married’ or sexually abused. They described how the fear of this stigma drives women to agree to be married either to violent men or as second wives, which is attached to lower status in the household, in turn increasing the risk of violence:

While polygamous marriages are common, women as second wives are seen to have less power in households than first wives. One social worker observed that women’s insecurities about social status combined with economic pressures to push them into relationships faster than their peers – some entering negative relationships, confirming their insecurities about having less value than other women. [ 29 ]

Annan and Brier (2010) also argued that forced marriage as part of armed conflict may have similar long-term psychological impacts on women as childhood experiences of violence, with similar consequences for difficult relationships with men in adulthood.

The qualitative results predominantly related to violence against women, but one study, Kohli et al. (2015), highlighted how the stigmatisation of violence against women has affected the mental health of children by contributing to social isolation in South Kivu, DRC:

Further, participants described how living in an unstable and violent household negatively affected children’s interaction with community members, as the entire family could become isolated and disrespected in the community. Male and female participants in this study described households with IPV as unable to progress or have stability in their lives. [ 31 ]

Study quality

Quality assessments for both quantitative and qualitative studies are in the Additional file 1 : Appendix. Overall, there was a low risk of bias in most of the quantitative studies. Bias existed in identifying and dealing with confounding, which we assessed as high or unclear in seven studies [ 30 , 37 , 40 , 45 , 48 , 50 ]. Sampling criteria were defined in all studies, with most adopting a version of random sampling. In some, for example O’Leary et al. [ 27 ], purposive sampling was used, leading to a likely bias.

The qualitative studies were generally of high quality, with the exception of the categories of cultural and theoretical positionality and reflexivity, for which we felt that all studies were lacking.

Conflict has a pervasive impact on people and societies. Conflict-related violence is well documented, but less well known is how exposure to armed conflict and its social and economic consequences can influence family violence and mental health problems. Our results provided evidence that family violence is common and is associated with poor mental health outcomes, but variability in outcomes and measurement meant that we were not able to support or refute the hypothesis that the prevalence increases in conflict settings nor that it changes the association with mental disorders.

Worldwide, approximately one in three women have survived physical or sexual violence, but the prevalence varies greatly by location. By WHO region, lifetime prevalence of physical or sexual intimate partner violence is highest in the Pacific (Melanesia 51%, Micronesia 41%, Polynesia 39%), South Asia (35%) and sub-Saharan Africa (33%) [ 52 ]. According to a recent WHO report, many countries with a recent history of armed conflict, including Afghanistan and Papua New Guinea, have some of the highest prevalences of physical and sexual IPV (46% and 51%, respectively), but data from conflict settings remain poor [ 52 ]. Our review found similar proportions, but the studies varied widely, most likely representing actual differences in prevalence, but also methodological issues such as study design, data availability, and tools used.

Studies of violence against children showed the almost ubiquitous presence of violence. It is estimated that one billion children have suffered from violence in the preceding year [ 4 ]. A systematic review by Hillis et al. from 96 countries (n = 38) summarised the prevalence of violence over the past year in any country. In Africa, Asia and North America, approximately half to two-thirds of children suffered violence. Prevalence in Latin America, Oceania, and Europe was a little lower, mostly at around one-third[ 4 ]. Direct comparison is limited as the countries included in the review by Hillis et al. did not overlap with ours, with the exception of Uganda, where they reported data from a randomised controlled trial [ 53 ]. Studies in our review reported recent violence at a similar prevalence in the studies from Afghanistan. The two Sri Lankan studies appeared to show a higher prevalence, reporting 64.2% [ 12 ] and 71.6% [ 41 ] in the past month alone. Amongst Violence Against Children and Youth Surveys (VACS) studies, only one country – Uganda – has comparable data [ 54 ]. This study reported a similar prevalence of lifetime family violence (59% against girls and 68% against boys). Conflicts themselves vary and the impact on individual families is different. Other factors may also affect health. For example, in a study from Sri Lanka, the population also experienced the Indian Ocean tsunami [ 12 ].

The finding of an association between violence and mental health problems is not new [ 55 , 56 ], and was reported in approximately half the studies of violence against women in our review. The studies were not amenable to meta-analysis, nor could comparisons be drawn readily with non-conflict settings. The most consistent association was with PTSD. This may be due to an increased risk of PTSD, as has been commonly shown in conflict-affected populations, but may also reflect a bias in the topics that are researched. For studies that included suicide risk and substance use as additional outcome measures, the association between exposure to family violence and prevalence broadly followed the dose–response relationship observed for PTSD.

Amongst studies of violence against children, consistent associations were found between family violence and symptoms of mental health problems. Three studies constructed structural equation models to explore associations [ 13 , 26 , 28 ]. Heath et al. [ 26 ] and Jewkes et al. [ 13 ] treated violence and mental health problems (PTSD and depression) as co-outcomes and did not examine the association between the two. Jewkes et al. showed the importance of household wealth and previous childhood trauma [ 13 ]. Saile et al.[ 28 ] proposed maternal care as a mediating factor that could reduce adverse mental health symptoms.

Armed conflict can challenge dominant masculinities that cast men as providers and heads of family in ways that contribute to perpetration of family violence [ 31 , 33 , 36 ]. Gender norms undermine women’s mental health during conflict by contributing to shame and stigma associated with experiencing both sexual violence and family violence more broadly, and this can also contribute to the social isolation of children [ 31 ]. However, the same destabilising effects of armed conflict can also give women new economic opportunities and contribute to their economic and social empowerment [ 29 , 30 , 35 ].

Strengths and limitations

The main strengths of the review included its robust search strategy, its use of dual reviewers, and analysis and synthesis of both quantitative and qualitative data. The review protocol was prospectively registered and the reporting followed established standards. Limitations should, however, be noted. Studies were highly heterogeneous and meta-analysis could not be conducted and pooled estimates of the association between exposure to family violence and mental health problems could not be calculated. Violence is likely to have been under-reported, and the extent of under-reporting and other biases in data collection would vary between studies and settings. Although a standardised approach for research on violence against children has been advocated (the Violence Against Children and Youth Surveys (VACS)), the studies included in the review did not follow this approach. Variation in outcomes would in part be due to the definitions used, with no set definition of family violence being accepted [ 57 ]. Our definition of family violence resulted in the inclusion of studies of violence against women and violence against children, but rarely was family violence explicitly defined within the studies.

Although we found consistent evidence of association between exposure to family violence and mental health problems for both adults and children, we can make limited inferences regarding causality due to the predominance of cross-sectional studies within the review. It is possible that both family violence and changes in mental health are outcomes of exposure to conflict, as described by Heath et al. [ 26 ] and Jewkes et al. [ 13 ], and reverse causality may occur [ 58 ].

In reviewing the qualitative studies, two forms of maltreatment of women (and children) not captured by our search terms are potentially salient for women’s mental health and could be rationalised under a broader conceptualisation of family violence. First, rejection and neglect following women and children’s return from conflict-related assault or time embedded with conflict groups affects their ability to reintegrate into family life, with implications for mental health. Second, sexual violence by combatants to entrap girls and women into forced unions could be viewed as initiating acts of both intimate partnerships and IPV.

Our systematic review showed that family violence was common in conflict settings and was associated with mental health outcomes. However, we were unable to determine whether prevalence or risk was greater than in non-conflict settings. This gap in the review stems from a lack of comparable data and reiterates the need for standardised measurement of both violence against women and violence against children. It also draws attention to the need to break down existing silos between research on violence affecting women and that affecting children to build a more comprehensive picture of the overlapping risks and mental health outcomes of violence within families [ 59 ]. A far more robust understanding of the impacts of armed conflict on families and their experiences of violence is urgently needed to develop comprehensive support systems in conflict-affected settings.

Acknowledgements

Authors' contributions.

The work was conceived by DD, JM and NM. Database searching by CR and NU. Data extraction and reporting by AN, AP, AU-C, CR, DD, NU and JM. Articles were assessed for quality by AP, AU-C, DD, JM. The manuscript was read and edited by all authors. All authors read and approved the final manuscript.

This review was funded by the National Institute for Health Research (Ref 17/63/47).

Availability of data and materials

Declarations.

Not applicable.

The authors declare that they have no competing interests.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Violence in Families: Assessing Prevention and Treatment Programs (1998)

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Using The “Family Violence Flag” To Better Identify Harm Within Families

This thesis looks at how the identification and recording of family violence offending in the criminal justice system could be improved. In doing so it examines s 16A of the Criminal Procedure Act 2011, which was introduced in 2019 to ensure “family violence offences” are identified as such on charging documents and on the offender’s criminal record. This provision is known operationally as the “family violence flag”. The role of the family violence flag in relation to risk assessment is considered, particularly its ability to reveal a perpetrator’s prior family violence offending. Research has shown that a history of family violence is the most consistently identified risk factor for intimate partner lethality and risk of re-assault. The potential of the family violence flag to improve the evidence-base of family violence offending in New Zealand is also considered, which is important given the prevalence and detrimental impact of family violence in New Zealand. Analysis suggests that despite its recent introduction, changes could be made to s 16A to increase its utility. Accordingly, reform options to s 16A are proposed to better achieve the policy intent of the family violence flag, strengthening both its application and subsequent use.

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5. teachers’ views of parent involvement.

The survey asked public K-12 teachers about the level of involvement they see from their students’ parents.

A bar chart showing that most teachers see parent involvement as insufficient, but less so in low-poverty schools.

Most teachers say parents do too little when it comes to:

Holding their children accountable if they misbehave in school (79%)
Helping their children with their schoolwork (68%)
Ensuring their children’s attendance in school (63%)

High school teachers (75%) are more likely than middle and elementary school teachers (60% and 56%) to say parents do too little to ensure their children’s attendance.

Larger shares of teachers in schools with medium or high levels of poverty than those in low-poverty schools say their students’ parents do too little in each of these three areas.

Differences by school poverty level are particularly large when it comes to parents helping their children with schoolwork and ensuring their attendance.

Virtually no teachers (shares ranging from 1% to 4%) say parents do too much when it comes to each of these things. Shares ranging from 18% to 34% say parents do about the right amount.

Teachers’ interactions with parents

Teachers report a mix of positive and negative interactions with their students’ parents, though relatively small shares say parents contact them extremely often or often to express satisfaction or dissatisfaction.

A horizontal stacked bar chart showing that about a quarter of teachers say parents frequently express appreciation for their efforts.

Most (65%) say parents show appreciation for their efforts at least sometimes, with 24% saying this happens frequently.

Fewer than half say parents at least sometimes communicate in a disrespectful way (40%) or that parents contact them to express support for (37%) or disagreement with (24%) what they’re teaching or things discussed in class. Shares ranging from 5% to 11% say these interactions happen frequently.

Elementary school teachers are more likely than middle and high school teachers to say their students’ parents frequently do each of the following:

Show appreciation for their efforts (31% of elementary school teachers vs. 20% of middle school teachers and 16% of high school teachers)
Contact them to express support for what they are teaching or things discussed in class (16% vs. 7% and 5%)

Physical violence from parents

While teachers report that parents can sometimes be disrespectful toward them, it’s uncommon for parents to get violent: 91% of teachers say they’ve never experienced a student’s parent being physically violent toward them. Still, 7% say this has happened to them.

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Table of contents, ‘back to school’ means anytime from late july to after labor day, depending on where in the u.s. you live, among many u.s. children, reading for fun has become less common, federal data shows, most european students learn english in school, for u.s. teens today, summer means more schooling and less leisure time than in the past, about one-in-six u.s. teachers work second jobs – and not just in the summer, most popular.

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Attitudes Toward Intimate Partner Violence Against Women in Moscow, Russia

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Published: 05 March 2008
Volume 23 , pages 447–456, ( 2008 )

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Andrew Stickley 1 ,
Olga Kislitsyna 2 ,
Irina Timofeeva 3 &
Denny Vågerö 4

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This study examines attitudes towards violence against women among the populace in Moscow, Russia using data drawn from the Moscow Health Survey. Information was obtained from 1,190 subjects (510 men and 680 women) about their perceptions of whether violence against women was a serious problem in contemporary Russia, and under what circumstances they thought it was justifiable for a husband to hit his wife. Less than half the respondents thought violence was a serious problem, while for a small number of interviewees there were several scenarios where violence was regarded as being permissible against a wife. Being young, divorced or widowed, having financial difficulties, and regularly consuming alcohol were associated with attitudes more supportive of violence amongst men; having a low educational level underpinned supportive attitudes among both men and women. Results are discussed in terms of the public reemergence of patriarchal attitudes in Russia in the post-Soviet period.

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Stockholm Center on Health of Societies in Transition (SCOHOST), Södertörns högskola, S 141 89, Huddinge, Sweden

Andrew Stickley

Institute for Socioeconomic Studies of the Population (ISESP), Russian Academy of Sciences, Moscow, Russia

Olga Kislitsyna

Baltic and East European Graduate School (BEEGS), Södertörns högskola, Huddinge, Sweden

Irina Timofeeva

Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institute, Stockholm, Sweden

Denny Vågerö

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Stickley, A., Kislitsyna, O., Timofeeva, I. et al. Attitudes Toward Intimate Partner Violence Against Women in Moscow, Russia. J Fam Viol 23 , 447–456 (2008). https://doi.org/10.1007/s10896-008-9170-y

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Received : 12 April 2007

Accepted : 15 February 2008

Published : 05 March 2008

Issue Date : August 2008

DOI : https://doi.org/10.1007/s10896-008-9170-y

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The Evening

Biden threatens to condition israel aid.

Also, ocean temperatures signal a daunting hurricane season. Here’s the latest at the end of Thursday.

By Matthew Cullen

During a tense 30-minute call today with Prime Minister Benjamin Netanyahu of Israel, President Biden threatened to condition future American support for Israel on whether it improves its treatment of civilians in Gaza. Biden called the humanitarian situation in the enclave “unacceptable,” and insisted to Netanyahu that he quickly put in place specific protections.

It was the first time that the president has sought to leverage American aid to influence the conduct of Israel’s war against Hamas , a step some of his closest allies have publicly supported. Biden’s frustration with Netanyahu has grown in recent months. But in public, he has staunchly supported Israel’s right to respond to Hamas’s Oct. 7 attack.

During the call, Biden urged Netanyahu to negotiate a deal that would result in an “immediate cease-fire” and the release of hostages taken by Hamas. A spokesman said the White House expects Israel to make announcements of specific changes within hours or days.

Secretary of State Antony Blinken, who dialed into the call, said afterward that Israel needed to do more to increase the flow of humanitarian supplies to Gaza, a challenge made more difficult after Israel’s deadly attack on an aid convoy this week.

“If we don’t see the changes that we need to see, there’ll be changes in policy,” Blinken said.

In related news, a key member of Netanyahu’s war cabinet called for early elections .

Ford slowed its push to electric vehicles

Ford announced today that it was delaying the production of at least two new electric cars and instead pivoting to make more hybrids. The new strategy followed similar moves by G.M. and Mercedes, as automakers have struggled to sell enough E.V.s to make the shift profitable .

Sales of E.V.s are still growing, but the pace has slowed sharply as car companies have tapped out many of the early adopters who were willing to spend more than $50,000 on a new battery-powered car. Now, those who are interested appear to often choose hybrid cars, which can offer good fuel economy and less of a learning curve.

Violence at the Darién Gap has spiked

The jungle straddling Colombia and Panama, known as the Darién Gap, is the only land route for South American migrants headed for the U.S. Thousands of people are trekking through it at any given time, and it has long been considered dangerous. But over the past six months, aid groups say, sexual violence there has spiked to an extraordinary level — one rarely seen outside of war zones.

Two of my colleagues spoke with more than 70 people over four days who said they had been robbed by clusters of armed men in the jungle. Of those interviewed, 14 were women who said they had experienced sexual assault, ranging from forcible touching to rape.

Ocean temperatures signal a daunting hurricane season

An area of the Atlantic Ocean where hurricanes often form has already become abnormally hot, conditions that one scientist called “unprecedented” and “alarming.” Combined with a diminishing El Niño weather pattern, which steers hurricanes from the East Coast, experts are forecasting an exceptionally high number of storms this hurricane season .

The research team at Colorado State expects a remarkably busy season of 23 named storms, nine more than usual and the most they’ve ever predicted this early in the year.

More top news

Immigration: A judge, responding to unsafe conditions at open-air camps near the border, said the U.S. must “expeditiously” house migrant children .

Trump: A federal judge rejected, for now, one of the former president’s central efforts to dismiss charges that he had mishandled classified documents after leaving office.

Politics: The centrist group No Labels abandoned its plans to run a presidential ticket this year.

2024: In important ways, both Biden and Trump have revealed less about their health than their predecessors .

Health: The A.L.S. drug Relyvrio will be taken off the market after a large clinical trial found it did not work better than a placebo .

Climate: The E.P.A. plans a $20 billion infusion into “green banks,” which lend money in overlooked communities for equipment that reduces pollution.

Tech: Companies are turning to A.I. to reduce food waste .

Tourism: To discourage overcrowding, Venice will start charging day trippers an entry fee to the historic part of the city on busy dates .

Physics: Scientists may have discovered a major flaw in their theory of dark energy, with good news for the fate of the universe .

TIME TO UNWIND

The eclipse will be an exciting day for science.

On Monday, the moon will cross over the sun, causing a total solar eclipse that will for a few minutes completely darken the sky over parts of North America. Many people have been eagerly awaiting the moment for months, but perhaps no one is as excited as scientists .

Researchers plan to send signals and launch rockets to see how the drop in sunlight affects radio and satellite communications. Photographs will be taken of the sun’s surface to measure its activity. And many scientists will be monitoring animals to see how they react to the sudden and surprising change in daylight .

A new take on ‘The Talented Mr. Ripley’

One of fiction’s most famous con artists returns today with the debut of Netflix’s “Ripley.” The new show, starring Andrew Scott as Mr. Ripley, is the latest in a series of adaptations of the cunning character created in the 1950s by the author Patricia Highsmith .

The Netflix show is written and directed by the Oscar-winning screenwriter Steven Zaillian, who decided to do away with color altogether. The result is beautiful and crisp black and white, or what our critic calls “ the chilly embrace of the art house .”

For more, here are the other movies and shows coming to Netflix this month .

Dinner table topics

From Korea to Italy: When Ayoung An was 8, she slept with a violin on her pillow. At 32, she is a rising star in the violin-making world .

Capital of college basketball?: N.C. State is done being seen as the little sibling to Duke and U.N.C.

Boat shoe buzz: A category of footwear created when Franklin D. Roosevelt was president is being reinterpreted and rediscovered .

Are eyedrops safe?: After a wave of recalls, we asked experts about how to avoid problems .

WHAT TO DO TONIGHT

Cook: This quick midnight pasta is a five-star recipe.

Watch: The director of “Música” explains how he pulled off the movie’s single-shot showstopper .

Read: A Philadelphia chef goes searching for her family history in “ The Sicilian Inheritance .”

Listen: Here are seven great songs for a gloomy spring day .

Snack: Oats are a good source of fiber, but they’re not a weight loss trick .

Share: If you’re retired, we want to hear about how it is going .

Hunt: Which Manhattan apartment would you buy with a budget of $800,000 ?

Play: Here are today’s Spelling Bee , Wordle and Mini Crossword . Find all of our games here .

ONE LAST THING

This might be a michelangelo. would you buy it.

Michelangelo was raised in a picturesque villa overlooking Florence, Italy. Legend has it that when he was young, he etched an image of a muscular nude man on the wall of a kitchen. Now, that drawing is up for sale.

But some experts doubt that he actually drew it, in part because it’s a bit ham-handed for such a master . One said that the artist had been “a very strict judge of himself” who destroyed many early works, adding that “maybe he forgot this one.”

Have an intriguing evening.

Thanks for reading. Emree Weaver was our photo editor today. I’ll be back tomorrow. — Matthew

We welcome your feedback. Write to us at [email protected] .

IMAGES

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2 FAMILY VIOLENCE AND FAMILY VIOLENCE INTERVENTIONS

COMMENTS

Children Witnessing Domestic and Family Violence: A Widespread Occurrence during the Coronavirus Disease 2019 (COVID-19) Pandemic
Across the world, children and adolescents are exposed daily to toxic levels of violent behaviors, including domestic and family violence. Violence increasingly has permeated and profoundly affected the lives of children, who are the most vulnerable members of society. 1 Pediatric societies in Europe and North America have raised great concern over the effect that abusive experiences will have ...
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DVA and violence against women (VAW). A key feature of this work entails expanding the scope of responsibility assigned to men for reducing DVA and men [s violence towards women, including within the context of the family. Using feminist, participatory based methods, the study elaborates a triangulated analysis of data from
The Impacts of Exposure to Domestic Violence in Childhood That Leads to
violence is defined as controlling behaviors that one repeatedly uses in order to gain power over their intimate partner (Capacity Building Center for States, 2018). Domestic violence can be used in many forms to inflict physical, emotional, social, and psychological harm to another (Capacity Building Center for States, 2018).
Violence in Families: Assessing Prevention and Treatment Programs
This array of interventions has been driven by the urgency of the different types of family violence, client needs, and the responses of service providers, advocates, and communities. The interventions now constitute a broad range of institutional services that focus on the identification, treatment, prevention, and deterrence of family violence.
Family Violence and Adolescent Aggressive Behavior: The ...
Prior literature suggests exposure to family violence often leads to aggressive behavior among adolescents. Despite this association, little is known of the potential explanatory variables that could link exposure to family violence and aggressive behavior, such as substance use and depressive symptoms. Thus, guided by the intergenerational transmission of violence theory, this cross-sectional ...
Mental health of women and children experiencing family violence in
Family violence was common in conflict settings and was associated with mental health outcomes, but the studies were too heterogenous to determine whether prevalence or risk was greater than in non-conflict settings. The review highlights an urgent need for more robust data on perpetrators, forms of family violence, and mental health outcomes ...
Home
Overview. Journal of Family Violence is a peer-reviewed publication committed to disseminating rigorous research on preventing, ending, and ameliorating all forms of family violence. Welcomes scholarly articles related to the broad categories of child abuse and maltreatment, dating violence, domestic and partner violence, and elder abuse.
The impact of family violence on the social and psychological ...
Abstract: Children may become victims of physical, sexual, emotional abuse. Our research aims to evaluate the effect of family violence on the child's social and psychological adaptation. 456 UAE University students voluntarily participated in the study. Child Abuse and Trauma Scale (CATS) were used to determine the level of domestic violence.
Mothering through and in Violence: Discourses of the 'Good Mother
Silke Meyer is Deputy Director of the Monash Gender and Family Violence Prevention Centre and an Associate Professor in Criminology. Her research centres on different aspects of domestic and family violence, including women and children's safety and wellbeing, men's accountability in their role as perpetrators and fathers, experiences specific to Indigenous communities and the nature and ...
The COVID-19 Pandemic and Family Violence: Reflecting on Two ...
Family Violence, COVID-19, Pandemic Mitigation, and Inequities. Broadly, emerging evidence shows connections between increases in IPV incidence and pandemic mitigation strategies implemented in response to COVID-19 (Piquero et al., 2021).Research also shows the confluence of economic and social disadvantages (e.g., financial and resource insecurity, mental illnesses, overcrowding, unemployment ...
(PDF) Family Violence
Of those who had experienced family violence, 29% (n=40) specified from 2 to 5 forms of harmful behaviour such as "name calling", "threaten", "isolating through preventing from seeing ...
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Family theories consider the family, a system or unit where all members interact with each other, as a site where violence perpetration can be generated, whether through stressors that all family ...
Policy Responses to Domestic Violence, the Criminalisation Thesis and
The first part of this article considers this thesis as it is articulated in present policy responses to domestic violence. The Criminalisation Thesis: Strengths and Weaknesses ... is that in the more than 100 years preceding the Domestic Violence Act 1976, it was family and property law which provided the widest range of opportunities for ...
(PDF) Lived Experiences of Domestic Violence in Women and Their
family life was full of struggles, to maintain a complete family, the women tried to seek Healthcare 2022 , 10 , 1556 6 of 11 social resources and only in this way could they continue to live.
PDF The impact of family violence on the social and psychological ...
Violence causes disorders and affects all levels of a child's personality development, his/her emotional and cognitive spheres, as well as behavior. One of the negative aspects of family life is the impact of domestic violence on children as witnesses or victims of conflict (Van der Kolk: 2017). According to some researchers, domestic violence ...
PDF A formative evaluation of an Aotearoa New Zealand family/whānau
1.1 Family Violence and Intimate Partner Violence: An Introduction Family violence is a broad term which encompasses physical, sexual, emotional and psychological abuse of and by children, parents, elders, siblings, and intimate partners (Social Policy Evaluation and Research Unit, 2017; Family Violence Death Review Committee
Violence in Families: Assessing Prevention and Treatment Programs
Journal of Family Violence 3(2):121-130. 1989 Counseling male spouse abusers: Characteristics of treatment completers and dropouts. Violence and Victims 4(4):275-286. 1991 Personality correlates of men who batter and non-violent men: Some continuities and discontinuities. Journal of Family Violence 6:131-147.
PDF Thesis Dispelling Domestic Violence Myths Among Graduate Social Work
domestic violence, including the In Her Shoes experiential learning activity. In Her Shoes was created as a way to "help participants understand, in a very compressed period of time, the ups and downs a battered women experiences over the course of many years (In Her Shoes: Living with Domestic Violence Reference Guide, 2000, p 1)."
Using The "Family Violence Flag" To Better Identify Harm ...
This thesis looks at how the identification and recording of family violence offending in the criminal justice system could be improved. In doing so it examines s 16A of the Criminal Procedure Act 2011, which was introduced in 2019 to ensure "family violence offences" are identified as such on charging documents and on the offender's criminal record. This provision is known operationally ...
5. Teachers' views of parent involvement
The survey asked public K-12 teachers about the level of involvement they see from their students' parents. Most teachers say parents do too little when it comes to: Holding their children accountable if they misbehave in school (79%) Helping their children with their schoolwork (68%) Ensuring their children's attendance in school (63%)
Russia's Police Tolerate Domestic Violence. Where Can Its Victims Turn
After a group of Russian legislators tried in 2012 to enact a law against domestic violence, the church's Commission on the Family objected even to the use of the term "violence in the family ...
Attitudes Toward Intimate Partner Violence Against Women in ...
Intimate partner violence is experienced by a large number of women throughout the world. According to survey estimates, between 10% and 69% of women report having been physically assaulted by a male partner at some point in time (Krug et al. 2002), with the lifetime prevalence of assault ranging between 10-64% in the World Health Organization's European region (Baumgarten and Sethi 2005).
The Khachaturyan sisters killed their father. Despite a history of
Domestic violence experts, along with the sisters' defense team, say that in the absence of adequate protective mechanisms within law enforcement and the court system, their only choice was to ...
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Sept. 2, 2019. MOSCOW — A Russian lawyer in the forefront of recent street protests in Moscow was arrested Monday evening in the Russian capital, along with a second opposition activist and an ...
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April 4, 2024, 5:53 p.m. ET. During a tense 30-minute call today with Prime Minister Benjamin Netanyahu of Israel, President Biden threatened to condition future American support for Israel on ...